Asbestos related diseases without asbestosis

Our plain-English summary of Asbestos related diseases without asbestosis, by D. Davies (British Medical Journal, 1983).

The study

• Author: D. Davies
• Journal: British Medical Journal
• Published: 1983;287(6386):164-5
• Type of article: Editorial
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001710).

Summary of the article

This editorial discussed a 1982 report by the Industrial Injuries Advisory Council, 'Asbestos-related disease without asbestosis', which proposed changes to the diseases prescribed for compensation under the British Industrial Injuries Scheme. Asbestosis and mesothelioma were already prescribed. The council recommended prescribing diffuse pleural thickening when it was bilateral, over 5 mm thick, and extended over more than a quarter of the chest wall. Pleural plaques and pleural effusions were not to be prescribed. The council also recommended prescribing primary lung cancer when it was accompanied by asbestosis, bilateral diffuse pleural thickening, or bilateral pleural plaques, irrespective of tumour type. US studies of insulation workers gave relative risks of lung cancer of 1 for non-exposed non-smokers, 5 for asbestos-exposed non-smokers, 11 for non-exposed smokers and 53 for exposed smokers. Citing these figures, the council recommended that smoking be disregarded. The author welcomed the extension of prescription but argued that pleural lesions were a less than satisfactory index of exposure. The reasons given were that pleural disease correlated poorly with asbestosis and could follow light exposure, that calcification usually took over 20 years from first exposure, and that only a minority of plaques were detectable during life. The author concluded that the proposals favoured people with pleural shadows from light exposure and discriminated against heavily exposed people without pleural lesions. The author also stated that the case for necropsies in exposed workers who died of lung cancer was clear.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

In this editorial, not a research study, a consultant chest physician discussed the recommendations of a 1982 report by Britain's Industrial Injuries Advisory Council on asbestos-related disease without asbestosis. Under these recommendations, diffuse pleural thickening in asbestos workers, once other causes such as infections were excluded, should qualify for disablement benefit if bilateral, over 5 mm thick and covering more than a quarter of the chest wall. Pleural plaques would not qualify. Lung cancer of any type should qualify when accompanied by asbestosis, bilateral diffuse pleural thickening or bilateral pleural plaques. The council recommended disregarding smoking when deciding these claims. The editorial cited United States studies of insulation workers, not new research, giving lung cancer relative risks of 1 for unexposed non-smokers, 5 for asbestos-exposed non-smokers, 11 for unexposed smokers and 53 for asbestos-exposed smokers. The author judged the pleural criteria probably a less than satisfactory index, favouring people with pleural shadows from light exposure over more heavily exposed people without pleural lesions. The author also wrote that the case for necropsies in exposed workers dying of lung cancer is clear.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial (commentary on a government advisory council report); no new data
• Who was studied: No people were studied; the editorial discusses compensation rules for asbestos workers in Britain under the Industrial Injuries Scheme
• Exposure: Occupational asbestos exposure in general (asbestos factory workers, insulation workers, shipyard workers, engineers); no fiber types are discussed in the editorial text
• Main results:
  • The diagnosis of diffuse pleural thickening depends on excluding other causes such as tuberculosis and other infections, collagen diseases, trauma, chronic uraemia and drug induced fibrosis; with such exclusions the council is satisfied that bilateral diffuse pleural thickening in asbestos workers is likely to be industrial
  • The council recommends disablement benefit for diffuse pleural thickening when it is bilateral, over 5 mm thick, and extends over more than a quarter of the chest wall
  • Pleural plaques are not to be prescribed
  • The council recommends prescription of primary lung cancer when it is accompanied by one or more of: asbestosis, bilateral diffuse pleural thickening, bilateral pleural plaques
  • The council recommends prescription irrespective of the type of lung cancer
  • Citing earlier US studies of insulation workers (not this article's data), relative risks of lung cancer were 1 (non-exposed non-smokers), 5 (asbestos-exposed non-smokers), 11 (non-exposed smokers) and 53 (asbestos-exposed smokers); the council therefore recommends that smoking be disregarded when deciding certification for lung cancer
• The authors' conclusion: The author concluded that the proposed pleural criteria are probably a less than satisfactory index of exposure, and that the case for necropsies in people with industrial asbestos exposure who die of lung cancer is clear

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Diffuse Pleural Thickening, Bilateral, Pleural Plaques, Pleural Effusion, Lung Cancer, Insulator, Relative Risk.

Related studies

• Asbestos-related disease without asbestosis--why not pleural asbestosis? — T. Beritić, S. Kovac (1985)
• Asbestos-related benign pleural disease — C. Peacock, S.J. Copley, et al. (2000)
• Compensation for asbestos-related diseases--the U.K. model — M. Britton (1989)
• Lump sum compensation for asbestos related lung disease — T. Williams, P. Slade, et al. (1998)
• Worker-sponsored survey for asbestosis: detection of occupational lung disease without a control group — D.H. Wegman, G.P. Theriault, et al. (1973)
• Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography — A.C. Friedman, S.B. Fiel, et al. (1988)

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